New York Train Derailment Thought Related to Operator Fatigue

Well, what many of us in the sleep health sciences feared might be the case appears to have been confirmed:  the operator of the New York commuter train that jumped off its rails early Sunday morning, December 1st, reportedly told federal investigators that he had “nodded” and “zoned out” just prior to the derailment.

 

The crash, which occurred in the Bronx and resulted in the death of four passengers and the injury of dozens, occurred when the train passed through a sharp turn at speeds much higher than recommended:  according to reports from the National Transportation Safety Board, onboard recorders clocked the train to be moving at a blazing-fast 82 miles per hour just prior to the crash (the speed limit at the track curve was 30 miles per hour).  Data also reportedly demonstrate that brakes were applied heavily and the throttle cut shortly (five seconds) before the locomotive and all seven coaches jumped off the tracks.  Reportedly, the train driver, 46 year-old William Rockefeller, told NTSB investigators that “I was in a daze” just prior to the crash.  Investigators appear to have have concluded that Rockefeller likely had experienced a “microsleep,” dozing briefly while operating the train.

I don’t know Rockefeller’s personal circumstances that may have been associated with this tragic incident.  But I can tell you in general terms is that excessive daytime sleepiness is a very common, under-recognized problem, one with the potential for huge adverse consequences for people who work in various industries, particularly ones that require substantial mental attention and high degrees of performance and concentration.  The medical literature abounds with data regarding the extent to which work performance may deteriorate with chronic sleep deprivation, for example.  As one may imagine, such mental deterioration may then lead to industrial accidents and fall-asleep vehicular crashes.  It is well known that excessive daytime sleepiness is associated with reduced performance and human error due to:

Slow or defective information processing
Non-response and/or delayed response
Slow (increased) reaction time
Reduced vigilance
Decreased situational awareness
Lapses in judgment
Reduced accuracy of short-term memory
Accelerated decrements in performance

There are several important problems associated with addressing the issue of excessive daytime sleepiness.  First, sleepiness during the day can be caused by all sorts of things, including deliberate sleep deprivation, irregular or rotating work schedules, jet lag, medications, alcohol, insomnia, or intrinsic sleep disorders such as untreated obstructive sleep apnea.  Second, daytime sleepiness is often insidious; it creeps up on you ’til before you know it, you’re struggling to stay awake and alert during the day every day.  Third, daytime sleepiness is not painful (until you get into a car wreck, of course), making it less likely that people will seek to have the problem evaluated by a health care professional.

So I’d like to provide some quick and dirty rules for you, in light of this most recent tragedy.

1.  Do what you can to get proper amounts of sleep.  The vast majority of adults require between 7.5 and 8 hours of sleep per night.  If you’re sleep-deprived, try going to bed tonight a little bit earlier than usual, like by 10-15 minutes.  A couple nights later, go to bed 10-15 minutes earlier than that.  Gradually increase the total amount of sleep per night, to as close to 7.5 to 8 hours per night as possible.  If you suddenly go to bed a couple hours earlier than you usually do, you may experience insomnia, and you may well end up going back to your usual pattern of sleep deprivation.

2.  Do what you can to get proper amounts of sleep regularly, i.e., as close to every night as you can.  Your body clock “wants” you to be regular in terms of your bed timing.  If you tend to “sleep in” on non-workdays, for example, the very fact that you are sleeping in may be an indicator that you need more sleep during other times of the week than what you’re allowing yourself to have.

3.  If you are struggling to stay awake and alert during the day despite proper amounts of sleep at night, seek medical attention.  You may want to see a person like me, a physician sleep specialist, if that is the case.

Sleep well, everyone, and stay safe.

 

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A Connection Between Exercise and Sleep

I’m a proud dad today.  Yesterday my boys both ran their first 5K race.  One, who turns 12 next March, outran me by an entire minute!  I’ve told my boys for years now that one of my goals is for them both to end up being better than me at everything, and that’s starting to happen now!

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A lot has been made of the relationship between exercise and quality of sleep over the years.  Recently, the 2013 National Sleep Foundation Sleep in America poll demonstrated “a compelling association between exercise and better sleep.”  Paraphrasing the data, those polled who did not exercise regularly indicated their sleep quality was “very bad” as compared to those who exercised regularly by a substantial margin:  14% as compared to 3-4%.  In addition, 76-83% of those who exercised regularly felt their sleep quality was “very good” or “fairly good,” as compared to 56% of those who did not exercise regularly, despite insignificant differences in sleep duration between the two groups.  These data and additional data from the poll support the longstanding idea of an association between good sleep habits and a lifestyle involving regular exercise.

We all know that regular exercise has been associated with improved overall health across a wide spectrum of parameters, ranging from cardiovascular fitness to mood.  Here are a couple simple exercise tips as pertains to your sleep:

1.  Exercise in the morning in general can help sleep quality and reduce the amount of time it takes to fall asleep once in bed at night.

2.  Though the notion of whether late-night exercise is detrimental to sleep has been challenged in recent years, I still recommend to my patients that it’s likely best to avoid intense aerobic exercise within 1-2 hours prior to their projected bedtimes; heavy aerobic activity can promote the release of stimulatory hormones.

3.  Consider exercise outdoors early in the morning.  The combination of aerobic activity and light exposure early in the day can further increase levels of wakefulness during the day and quality of sleep at night.

4.  Keep in mind:  the promotion of great sleep habits and hygiene originates from the same mindset that generates a schedule that includes regular exercise:  discipline to maintain a lifestyle geared toward good health, happiness, and longevity.  Use the same discipline for your sleep as you do to get yourself to the gym.  Stay regular with your sleep times and sleep scheduling.  Awaken around the same time every morning to the extent that you can.

5.  Your exercise tolerance and energy levels probably will improve with proper amounts of sleep every night!  Obey your body’s intrinsic need for sleep; most adults require around 7.5-8 hours of sleep per night, regularly, to feel fully awake and alert during the day.

Stay healthy, everyone!

 

Are You Ready For Some Football?

Indulge me for a moment.  Walk outside, stand quietly, and take in a deep breath.  What do you smell?  What is that that you sense?  You know what it is.  It’s the coming fall.

I love autumn.  Always have.  Even though I’ve been (thankfully) out of school for many moons now, the fall season to me is still all about the start of the new school year (now for my kids), intellectual beginnings and renewals, new activities, a prelude to colder weather and the holiday season, and, of course, that great American institution, football.

 

 

Truth be told, I’ve always been more of a basketball fan than a football fan, but I thoroughly enjoy a good gridiron game now and then.  Our Seattle Seahawks are lookin’ great this year, but I have mixed feelings and loyalties regarding the upcoming preseason rematch with the Green Pay Packers, my first NFL love (having spent 5 years of my childhood in south central Wisconsin).  Admittedly, what I love more than the game itself is the feeling of football season:  those bright crisp autumn days, the stadiums, the pulse of the marching band (in which I participated all through high school), tailgating parties, communion with close friends while rooting for our team.  That nondescript but powerful feeling remains part of why autumn has always been my favorite season.

Why is football pertinent to a discussion regarding sleep, other than sleepless nights from all the excitement?  Football players–particularly defensive and offensive linemen–have a particularly high risk of having obstructive sleep apnea, a breathing disorder in which prolonged pauses in breathing–due to closure of the upper airway–are followed by brief arousals from sleep, thus leading to symptoms such as nocturnal sleep disruption and substantial daytime sleepiness and fatigue.  Unfortunately, untreated sleep apnea increases the risk for developing heart disease, high blood pressure, and sudden cardiac death during sleep.  Reggie White, for example, was a Green Bay Packer whose tragic, unexpected death at 43 years of age has been attributed to sleep apnea.

 

People often–and mistakenly–presume that you need to be obese to have sleep apnea.  Though certainly it is true that being overweight increases your risk of developing sleep apnea because of increased soft tissues surrounding your airway, you don’t need to be obese to have the problem.

Many or most college and professional football players are not necessarily obese, per se, but they tend to be big people, obviously, often with large necks due to hypertrophied neck strap muscles.  In general, having a big neck does increase your statistical risk of developing or having sleep apnea.  In a clinical setting, the magic number is 17:  adults with shirt collar sizes of 17 or higher are at increased risk.

 

Earlier this month, the American Academy of Sleep Medicine announced its campaign to raise awareness of sleep apnea in football players.  CBS Sports college football analyst Aaron Taylor (also formerly a Packers player) is helping the AASM get the word out regarding the importance of diagnosing and treating sleep apnea:  he himself has been diagnosed with this disorder, and he has enjoyed substantial clinical benefit from being treated.  I appreciate the fact that Mr. Taylor is encouraging athletes to consider sleep apnea diagnosis and management.

 

To read more of Taylor’s story, click here:

http://www.sleepeducation.com/news/2013/08/08/aaron-taylor-warns-young-football-players-to-be-aware-of-sleep-apnea-risk

The take-home point here tonight is that certain athletes are at risk of having sleep apnea–such as football players and wrestlers–in part related to increased neck size, even if not due to fat.  If you know someone who is a football player, and if that person is a loud snorer who tends to feel tired and sleepy during the day, it may well be beneficial for that person to seek medical attention.  Treating sleep apnea can result in dramatic improvements in levels of energy and wakefulness during the day, and may even improve muscular strength and athletic endurance.  Then, hopefully, everybody wins:  players, families, teams, and fans!

It should be a great football season, y’all, and not a bad prelude to Jayhawk basketball!  Cheers, everyone!

Sleep Well This Summer, Part 3: Keep Your Bedroom Quiet

It’s been a while since my last entry; too much going on this summer!  I hope you all are staying cool; it’s been a scorcher throughout most of the U.S. this month.

In recent entries we tackled how to keep your bedroom dark and cool.  I’m finishing off this summer sleep writing triad today with some tips on how to keep your sleeping environment quiet during these summer months.

Summer presents some challenges to sleeping in a peaceful quiet place.  It’s light out late, it’s vacation time, the kids are out of school, and the heat’s got people a little crazy.  So there are block parties, summer traffic, teenagers out raising a ruckus in their back yards, barbecues that run late . . . you know, all the stuff that’s great fun when you’re in the fun, but not so fun when you’re in your bedroom trying to get some winks.

As I’ve mentioned before, sleeping during the summer months is best achieved if you keep your sleeping environment dark, cool, and quiet.  Here are some suggestions to make for a quiet place in which to sleep.

1.  Fix broken or uneven windows and door and window frames, basically anything that can cause a draft.  Things that leak in unwelcome air will also leak in unwanted noise.  Doing so will probably reduce your energy bills too.

2.  Fortify your windows to insulate them from noise.  Try thicker glass or double-paned glass.  A cheaper and easier alternative would be to place thick, black curtains in front of the windows.

3.  Try a little “white noise,” particularly if you live in an area in which outside noise is unavoidable (train tracks, a busy intersection, or what have you).  A fan works well, because the convective effect of the circulating air cools you down as well.

4.  If you live in an apartment, request a corner apartment farthest away from the street.  And preferably as far away from loud, selfish, obnoxious neighbors as possible.

5.  Sleep in a room closest to the center of your dwelling.  The more drywall that separates you from the outside world, and the fewer windows in the room, the quieter in general your sleeping environment will be.

6.  Sleep in the basement, if you must.  Nothing like surrounding earth to insulate you from the noise and heat in the summertime.

7.  Though earplugs may be helpful, I personally advise against this, simply because you want to be able to hear potential problems around the house:  a crying baby, for example, a fire alarm, etc.

8.  If your bed partner snores substantially, discuss this with your bed partner and consider informing his or her physician.

9.  This is embarrassingly obvious, but turn off whatever beeping, pinging, whirring, droning electronic gadgets you have in your bedroom if you possibly can.

10.  Turn off TV’s, radios, and iPods.  Many people feel like they can’t sleep without background noise from such gadgets, but let me assure you that the reason why this feels this way is because of simply habituation:  your body does not biologically require such noises, but if you’ve had some sounds in the room at night for years, it feels like you need them when you don’t.  Turn off these devices and you should fairly quickly come to enjoy the silence.

11.  Particularly if you work night shifts, have open discussions with your family and loved ones about how to keep the noise of other people from disrupting your sleep.  As with most other situations, it’s always best to communicate openly and honestly about such topics!

Enjoy the rest of our summer, everyone!  I wish you deep, comfortable sleep!

 

Sleep Well This Summer, Part 2: Keep Your Bedroom Dark

Hi, all!  This is the continuation of my short series how to sleep well during the warmer and longer days of summer.  As mentioned in Part 1, people generally find a dark, cool, quiet environment most conducive to sleep.  Today’s entry is devoted to improving your sleep by keeping your sleeping environment dark.

 

By way of background, light is an extremely potent outside influence on your “body clock,” which regulates the timing of certain biological functions of your body.  Exposure of your retinas to light stimulates a neurologic pathway through your brain, essentially telling your body clock it’s time to be awake.  As such, exposure to light shortly upon arising in the morning can cause you to feel more awake and alert, and bright light exposure late at night can cause insomnia.  Even relatively modest light can have a stimulatory effect.  It makes sense, then, that shielding your bedroom from bright light is important during the summer, when the sun often shines relatively late into the evening, carrying both light and heat into your room.

Here’s a couple of considerations to darken your room.

1.  Sleep in a room without windows.  If you can.  Basements are great for that, for example, and some of my patients simply migrate to a basement bedroom each summer to sleep better.

2.  Sleep in a room which has windows that don’t face westward.  The sun sets in the west.

3.  Cover your windows.  I recognize this seems obvious, but it’s amazing how many people sleep in bedrooms with bare windows.

4.  Cover your windows with something dark (preferably black) and thick, such as black curtains.  Venetian blinds generally don’t do a great job of shielding the room from light.

5.  Turn your bed away from your windows.

6.  Turn off all the lights and the television when you’re ready to go to sleep.  Again, I’m stating the obvious here, but many people sleep with lights and other electronics on.

7.  Turn around or turn off glowing electronics, like digital alarm clocks.  If you’re an insomniac, turning your nightstand clock around will have the added benefit of keeping you from the deadly habit of “clock-watching,” which I’ve written about in previous entries.  It would also be helpful to turn off the lights one night and simply look around the room, looking for electronic lights.  You might be surprised about how much glowing, blinking stuff coinhabits your sleeping space, from your DVR, stereo, laptop, cable box, or whatever.  Turn off or hide whatever light sources you can, even if they’re small.  Turn down brightness levels as well if possible.

8.  Reconsider your nightlight.  Some people have long slept with a nightlight without problems, but bed partners may be bothered by this.  Discuss this with your spouse or bed partner.  If a nightlight is absolutely necessary, consider getting one that can be dimmed.

9.  If necessary and if all else fails, sleep masks or even dark sunglasses can help.  Hopefully, however, you can keep your entire bedroom dark throughout the night.

Sleep well, everyone!  The third and final entry in this series:  how to keep your bedroom quiet during the summer.  Enjoy these months of warmth:  winter is coming.

It’s Not About the Nail!

In this video, a woman describes some difficulties she’s had recently:  a multitude of strange, bothersome symptoms, including problems sleeping.  Take a look.

I thank my great friend and former partner in crime, David B., for bringing this piece to my attention.  It’s absolutely hilarious, but this video short does illustrate a couple important and serious reminders for me, however.

First, for each of us, there may be times in which the underlying cause of a problem can be right under your nose (or in this case, nailed to your forehead) for ages before it’s realized.  I saw a woman in my clinic this morning, for example, for her insomnia.  She’s awakened at 3 a.m. every morning because her cat sits on her face.  She told me she then gets up to put the cat into the garage.  I asked her how often she does this.  Her answer:  “every night.”  Sooo . . . why not put the cat in the garage at the beginning of the night before bedtime?  My point is that we’re creatures of habit, and we’re used to what we’re used to.  Whether we’re talking about sleep hygiene or a nail protruding from your head, what you’re used to is your “normal.”

Second, though we docs are trained and conditioned to move quickly to act and save our patients from their medical problems, sometimes what is asked of us is to just listen.  Given the changes happening in health care at the moment, I fear that the doctor’s ability to spend the time to listen to our patients will become as extinct as the dinosaurs.  Many feel that it already is.  I hope that someday there will again be a place for more humanity in the administration of health care.

Have a great evening, everyone, and remember, “it’s not about the nail!”

Morgan Freeman Falls Asleep During an Interview

I can’t resist.

The other day actors Michael Caine and Morgan Freeman conducted a live interview with Bill Wixey and Kaci Aitchison from Q13 Fox News right here in Seattle.  The interview centered around their upcoming film, Now You See Me.  But as you now see here in this abridged clip, Mr. Freeman was having a bit of a struggle staying awake while Mr. Caine spoke.

I like in particular how he arouses briefly, nods his head slowly, as if he’s been fully attentive the entire time, and drifts back off.

Here is an online article, which includes Bill Wixey’s post-interview reaction and also the full video interview with Caine and Freeman.  It’s worth watching the entire interview here:  there is much more sleep time than what is seen in the brief clip above.

http://mynorthwest.com/76/2280849/Seattle-news-anchor-puts-Morgan-Freeman-to-sleep

Now, to be fair about this, this soporific faux pas is likely not Freeman’s “fault,” and is probably not due to boredom, as at least one journalist has suggested.  It appears that Caine and Freeman were interviewed from a studio in New York.  I’m guessing Freeman had flown from Los Angeles to New York shortly prior to the interview, and if this was the case he was probably recovering from jet lag.

Remember, there’s a 3-hour time difference between the west coast and the east coast.  Sleepwise, it’s particularly tough to go from the west coast to the east coast, because upon arrival your brain is essentially asked suddenly to go to bed earlier and awaken earlier than usual, setting you up for insomnia and sleep deprivation.  I know this from experience:  I fell asleep at my table and virtually fell out of my chair once during a loud, boisterous classic rock awards banquet shortly upon arriving in London several years ago.

Additionally, in general, the older we get, the less tolerant our bodies become to insomnia, sleep deprivation, and shifts in our usual sleep scheduling.  So I definitely empathize with our nearly 76 year-old Mr. Freeman, who was sitting in a comfortable, quiet environment during the interview, his uncooperative body clock begging for a snooze.

One final comment.  I’m often asked if you fall asleep during the day just because you’re bored.  The answer is no.  However, if you are prone to becoming excessively sleepy during the day (due to sleep deprivation, an untreated sleep disorder, or the like), then your sleepy tendencies will be more likely to express themselves in the form of falling asleep by accident when you are sedentary as compared to when you’re active.  When you’re bored you’re usually sedentary, so in that setting you’re therefore more likely to fall asleep.  This is an important distinction to make; many people don’t get evaluated for their sleep disorders because they believe that falling asleep frequently during the day is normal because they’re bored.

 

Have a good, wakeful day, everyone!